Scientific letters
Complete malignant gastro-duodenal outlet obstruction and direct endoscopic ultrasound-guided gastroenterostomy
Obstrucción gastroduodenal maligna completa y gastroenteroanastomosis directa guiada por ecoendoscopia
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Small areas of infarction in liver segment 7.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Belén Martínez Benito, Víctor González Pintor, Lourdes del Campo del Val, Luisa García-Buey" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Belén" "apellidos" => "Martínez Benito" ] 1 => array:2 [ "nombre" => "Víctor" "apellidos" => "González Pintor" ] 2 => array:2 [ "nombre" => "Lourdes" "apellidos" => "del Campo del Val" ] 3 => array:2 [ "nombre" => "Luisa" "apellidos" => "García-Buey" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210570523004302" "doi" => "10.1016/j.gastrohep.2023.09.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570523004302?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424000877?idApp=UINPBA00004N" "url" => "/24443824/0000004700000006/v2_202409200854/S2444382424000877/v2_202409200854/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letters</span>" "titulo" => "Complete malignant gastro-duodenal outlet obstruction and direct endoscopic ultrasound-guided gastroenterostomy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "622" "paginaFinal" => "624" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Joan B. Gornals, Dani Luna-Rodriguez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Joan B." "apellidos" => "Gornals" "email" => array:1 [ 0 => "jgornals@bellvitgehospital.cat" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Dani" "apellidos" => "Luna-Rodriguez" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universitat de Barcelona, Catalonia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Obstrucción gastroduodenal maligna completa y gastroenteroanastomosis directa guiada por ecoendoscopia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2147 "Ancho" => 3458 "Tamanyo" => 567798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case #4. Fluoroscopy and endoscopy view of a completed malignant gastric outlet obstruction (A and B). Ascites and a collapsed small bowel close to the gastric wall is EUS-guided punctured using a 22G needle (safer and better penetrability for accessing into the enteral lumen), filling contrast and saline into the target small bowel (C). Fluoroscopy confirmation (D). Once enteral lumen gains enough diameter, a second EUS-guided puncture with 19G needle (offering faster flow of liquid) is performed (E). Fluoroscopy confirmation of the successful gastroenterostomy, after direct “free-hand” method using an electrocautery-enhanced lumen-apposing metal stent (HotAxios;15<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Endoscopic ultrasound (EUS)-guided gastroenterostomy (GE) remains an evolving endoscopic technique. Two most reported technical variants include the balloon-assisted gastroenterostomy (BAGE) and the direct gastroenterostomy (DGE) approaches. In both, usually the obstruction grade allows the fluid infusion through the scope, catheter advancement for filling the bowel, or facilitating the localization and puncture of the small bowel. In some centres, a confirmatory EUS-guided puncture is performed to confirm the correct punction site or advancing a guidewire to facilitate the lumen-apposing metal stent (LAMS) deployment.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> In our opinion, this confirmatory step maybe avoided once the distended bowel is well visualized with the direct EUS-guided GE simplified technique using a feeding-tube waterjet system.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In all these previous exposed techniques, locating the distal segment to the gastric outlet obstruction (GOO) is possible through the tumoral lumen. But what to do in cases of complete obstruction when it is not possible to even advance a guidewire through?</p><p id="par0015" class="elsevierStylePara elsevierViewall">From 2021 to 2023, more than 70 EUS-guided GE procedures have been included in a multicenter prospective study conducted at the Barcelona Area (GESICA study; <a href="ctgov:NCT05128604">NCT05128604</a>) by using this simplified direct technique (oro-enteral catheter for filling the bowel followed by ‘free-hand’ direct penetration of LAMS). But, in four cases (5.7%), it was not possible to apply this technique due to a completed GOO.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our aim was to report the outcomes of a first-case series (<span class="elsevierStyleItalic">n</span>−4) for managing complete malignant GOO with EUS-guided GE as a direct-method without additional catheters, only using an FNA needle to access a collapsed small bowel for filling its lumen.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Technical success was defined as correct filling of the collapsed small bowel, and adequate positioning and deployment of the stent by EUS/fluoroscopy view. Clinical success was defined as the ability to tolerate at least a full liquid diet. Feasibility, adverse events (AEs) and efficacy were evaluated.</p><p id="par0030" class="elsevierStylePara elsevierViewall">All the procedures were performed under general anaesthesia by an anaesthesiologist. Written informed consent was obtained for EUS-guided intervention. In all cases, anaesthesia was attempted under endosonography/fluoroscopic guidance, and antiespasmodic agents were administered.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Four patients were referred with complete malignant obstruction and consecutively treated with this endoscopic approach. Firstly, EUS-guided identification of the collapsed small bowel at the Treitz area was performed.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Secondly, EUS-guided puncture using a 22G needle (without stylet and flushed with saline), filling contrast and saline into the lumen bowel. Sometimes, a submucosal injection of the enteral wall was recognized. In two cases, all procedure was done using a single 22G needle. In the remaining cases, once the lumen gained enough diameters, an exchange to 19G needle was done. Then, a water pump was connected directly to the 22G or 19G needle. Lastly, once the small bowel was largely distended, the direct “free-hand” method using an electrocautery-enhanced LAMS (HotAxios; Boston Sc) was successfully used. After intra-LAMS dilation (optional), spontaneous water drainage and visualization of the enteral lumen confirmed the successful GE. All cases were admitted to our centre for clinical observation. Patients started correctly oral feeding within the next 8<span class="elsevierStyleHsp" style=""></span>h and clinical success was confirmed in all of them.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Regards safety, one AE (aspiration pneumonia) was reported, related to the orotracheal intubation. No AEs were related to the EUS-guided approach. General outcomes are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Patient #2 required two procedures for achieving technical success. In a first failed session, a 19G needle was used as a first attempt to access a collapsed bowel. In a second session, EUS-GE was successfully done using a 22G for all procedures. Though it has been reported the direct use of a 19G needle, given that in most cases the small bowel will collapse, the first attempt to access inside the enteral lumen may be easier using a 22G needle.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Our study has some limitations. A small sample size; a challenging demand in reaching a collapsed small bowel lumen; and the potential risk of pushing the jejunum away instead of penetrating, resulting in distal flange deployment in the peritoneum. It requires expertise in EUS-guided puncture, knowledge and abilities in salvage methods (as NOTES), and innovations on designing dedicated devices for stabilizing the targeted loop for puncture.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In summary, direct EUS-guided GE of complete gastro-duodenal obstruction seems to be feasible, effective, and this strategy may prevent the need for more invasive options such as surgery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical approval</span><p id="par0060" class="elsevierStylePara elsevierViewall">Informed consent was obtained from the patient for the publication of their information and imaging. This study was conducted in accordance with the principles of the Declaration of Helsinki and the guidelines for Good Clinical Practice. This study was approved by the research and ethics committees (Comité Étic d’Investigación Clínica, Hospital Universitari de Bellvitge; no. ICPS011/22; May 2022). Participants are recruited in a multicenter prospective study (GESICA study), registered at ClinicalTrials.gov on November 2021 (<a href="ctgov:NCT05128604">NCT05128604</a>).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0065" class="elsevierStylePara elsevierViewall">D. Luna-Rodriguez was involved in the analysis and interpretation of the data, critical revision, and final approval.</p><p id="par0070" class="elsevierStylePara elsevierViewall">J.B. Gornals, involved in the conception and design, analysis and interpretation of the data, drafting of the article, critical revision and final approval.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">No grant support.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">Dr. Gornals is a consultant for BostonSc. The other author has no conflicts of interest to disclose.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical approval" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2147 "Ancho" => 3458 "Tamanyo" => 567798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case #4. Fluoroscopy and endoscopy view of a completed malignant gastric outlet obstruction (A and B). Ascites and a collapsed small bowel close to the gastric wall is EUS-guided punctured using a 22G needle (safer and better penetrability for accessing into the enteral lumen), filling contrast and saline into the target small bowel (C). Fluoroscopy confirmation (D). Once enteral lumen gains enough diameter, a second EUS-guided puncture with 19G needle (offering faster flow of liquid) is performed (E). Fluoroscopy confirmation of the successful gastroenterostomy, after direct “free-hand” method using an electrocautery-enhanced lumen-apposing metal stent (HotAxios;15<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">F, female; G, gauges; HXS, HotAxioS; LAMS, lumen-apposing metal stent; M, male.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age in years/sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Malignant aetiology \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ascites \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Procedure time(min) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number and size of EUS needle \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LAMS size<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Technical success<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>(Y/N) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical success<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>(Y/N) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adverse events \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pancreas/duodenum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First 22G, secondly 19G \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HXS, 15–10<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pancreas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Only 22G \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HXS, 20–10<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>(two attempts) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aspirationpneumonia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pancreas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Only 22G \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HXS, 15–10<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gastric \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First 22G, secondly 19G \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HXS, 15–15<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3662059.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Technical success, defined as adequate positioning and deployment of the stent as determined by endoscopy view.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Clinical success defined as the ability to tolerate at least a full liquid diet.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">A second endoscopic approach was need. First approach, the small bowel was attempted to be punctured using a 19G but without gaining correct access into the lumen.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Preference for 15-mm over 20-mm in diameter size, is for safety, since smaller diameter entails less catheter advancement length within the target.</p>" ] 4 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Ascites presence is a relative contraindication (previous evacuating paracentesis can be considered).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">General outcomes summarized.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.W. van der Merwe" 1 => "R.L.J. van Wanrooij" 2 => "M. Bronswijk" 3 => "S. Everett" 4 => "S. Lakhtakia" 5 => "M. Rimbas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/a-1717-1391" "Revista" => array:6 [ "tituloSerie" => "Endoscopy" "fecha" => "2022" "volumen" => "54" "paginaInicial" => "185" "paginaFinal" => "205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34937098" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EUS-guided gastroenterostomy: techniques from East to West" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Irani" 1 => "T. Itoi" 2 => "T.H. Baron" 3 => "M. Khashab" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.vgie.2019.10.007" "Revista" => array:6 [ "tituloSerie" => "VideoGIE" "fecha" => "2019" "volumen" => "5" "paginaInicial" => "48" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32051906" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct endoscopic ultrasound-guided gastroenterostomy using a feeding-tube waterjet system: a teaching video to facilitate understanding of the technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.F. Consiglieri" 1 => "D. Luna-Rodriguez" 2 => "A. Garcia-Sumalla" 3 => "S. Maisterra" 4 => "J.G. Velasquez-Rodriguez" 5 => "J.B. Gornals" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/a-1523-0780" "Revista" => array:6 [ "tituloSerie" => "Endoscopy" "fecha" => "2022" "volumen" => "54" "paginaInicial" => "447" "paginaFinal" => "448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34087945" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic ultrasound-guided gastroenterostomy with water-jet filling technique through a 19G needle to treat complete malignant duodenal obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Collin" 1 => "S. Brahmia" 2 => "F. Rostain" 3 => "A. Lupu" 4 => "L. Calavas" 5 => "J. Jacques" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Endoscopy" "fecha" => "2021" "volumen" => "53" "paginaInicial" => "7" "paginaFinal" => "8" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Helpful technical notes for intraperitoneal natural orifice transluminal endoscopic surgery (NOTES) salvage in a failed EUS-guided gastroenterostomy scenario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.B. Gornals" 1 => "C.F. Consiglieri" 2 => "S. Maisterra" 3 => "A. Garcia-Sumalla" 4 => "J.G. Velasquez-Rodriguez" 5 => "C. Loras" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Endoscopy" "fecha" => "2022" "volumen" => "54" "paginaInicial" => "287" "paginaFinal" => "289" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004700000006/v2_202409200854/S2444382424000889/v2_202409200854/en/main.assets" "Apartado" => array:4 [ "identificador" => "48446" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004700000006/v2_202409200854/S2444382424000889/v2_202409200854/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424000889?idApp=UINPBA00004N" ]
